Omental Patch Repair for Duodenal Ulcer Perforation- Analysis of Factors Affecting Outcome: A Prospective Study

Abstract

Background/Objectives: Primary repair of duodenal perforations with the omental patch technique has re-emerged as the mainstay of treatment of this widely-prevalent condition, especially in our country. We have prospectively studied factors affecting outcome (morbidity, mortality) of duodenal ulcer perforations treated by omental patch technique, and have also attempted to study the efficacy of contemporary scoring systems (Haceteppe, APACHE II, Mannheim Peritonitis Index, Jabalpur score) in predicting outcome. Methods: One hundred consecutive patients of non-traumatic duodenal ulcer perforations (NTDUP) over a 2-year period were recruited for this prospective study at a tertiary care hospital in Delhi, India. Clinical and laboratory data, and, outcome, were recorded; all patients were treated with omental patch repair. Results: In 100 patients, there were 97 male (mean age= 40.8 ± 14.2 years) and 3 female (mean age= 38.3 ± 12.6). Fourteen patients recovered completely, 86 had complications; of the latter five died. Age, serum creatinine, and perforation size were associated with unfavourable outcome (p=0.015, 0.000, 0.013 respectively; students t-test). Presence of hypotension, serum creatinine, perforation-operation interval (PO), and perforation size, were associated with mortality alone (p=0.000, 0.001, 0.001, 0.000 respectively; student's t-test). Age, serum creatinine, PO, and perforation size had correlation with longer hospital stay (p=0.044, 0.005, 0.012, 0.003 respectively; Pearson's coefficient). Using receiver operating characteristic (ROC) curves, only the APACHE II and the Jabalpur scoring systems accurately predicted poor outcome. Conclusions: Omental patch is a safe and effective method of closure of duodenal perforations. Other procedures may be combined if high-risk factors are identified, e.g., large perforation size. The Jabalpur score is a simple tool in large emergency rooms with limited facilities.